Head and neck cancer mortality in the United States: Regional differences in hospice use and place of death

Background With more than 15,000 annual deaths from head and neck cancer (HNC), an important aspect of end-of-life care for these patients is place of death. Recent evidence suggests an increasing preference for home/hospice at end of life; however, it is unclear whether there is variation in home/hospice use based on region or urban status. We described differences in the place of death of HNC patients based on their region and urban status. Methods Using the CDC WONDER (Wide-Ranging Online Data for Epidemiologic Research) database for HNC mortality (1999 to 2019), place of death was dichotomized as home/hospice vs. other, by Health and Human Services (HHS) region (Regions 1-10), and by urbanization status. Multivariable logistic regression analyses estimated odds of place of death being home/hospice, and being urban/metro, adjusting for both clinical and nonclinical variables. Results Over the study period, there were 260,630 deaths, 47.4% of which were at home or hospice. Compared to patients in New England/Region 1 (CT, ME, MA, NH, RI, and VT), HNC patients were more likely to die at home/hospice in the Pacific Northwest/Region 10 (AK, ID, OR, WA) (aOR (1.73; 95% CI: 1.64, 1.83) and less likely in the Eastern Section/Region 2 (NJ, NY, PR, VI) (aOR 0.93; 95% CI: 0.89, 0.97). Further, large central metro areas had significantly lower rates of dying at home/hospice than did all other settings. Conclusion Patients in moderately urban areas were reported to have the greatest use of hospice services and at-home death; patients in the HHS Region representing Alaska, Idaho, Oregon, and Washington were also found to have the highest rates of use. These differences in hospice care should be considered when clinicians counsel patients on their end-of-life options.